Preliminary study on early microvascular ingrowth into distracted callus during distraction osteogenesis-A non-invasive approach to explore the early growth patterns and possible mechanism of distraction osteogenesis in vivo.

Authors

Juan Li, Yonghong Zhang, Yutao Zhang, Dong Wang, Wei Luo, Xiaojin Gao, Yanping Wang, Ruhao Zhang, Yan Li, Ze Zhang, Xinghua Wang, Yanzi Qiao, Weiwei Wu, Bojuan Wang, Hongjie Zhou, Chaoqi Wang, Zemin Liu, Wei Han, Yanming Zhi, Jia Li, Sihe Qin

Published in

Bone. Pages 118138. Oct 18, 2026. Epub Oct 18, 2026.

Abstract

Distraction osteogenesis (DO) is critical for repairing large segmental bone defects. Early callus vascularization is essential for bone regeneration; however, real-time microcirculatory assessment remains lacking. This study aimed to elucidate spatiotemporal microvascular network construction in distracted callus using super-resolution contrast-enhanced ultrasound (SR CEUS) and high-frame-rate contrast-enhanced ultrasound (HiFR CEUS) in a sheep tibial DO model.
Six sheep underwent tibial DO. On day 7 of distraction, B-mode ultrasound, "Firefly" imaging, SR CEUS, and HiFR CEUS were performed. Quantitative parameters including vessel density (VD), perfusion index (PI), mean intensity, and peak intensity (PKI) were compared among three regions: central high-perfusion area (CHPA), annular low-perfusion area (ALPA), and peripheral high-perfusion area (PHPA).
B-mode ultrasound revealed outward bulging of distracted callus. "Firefly" imaging detected microcalcifications. SR CEUS showed PHPA (67.58% of cross-sectional area) received centripetal blood flow from periosteum and surrounding soft tissues; CHPA (10.39%) received centrifugal flow from the medullary cavity; ALPA (22.03%), located between them, exhibited significantly lower mean intensity than CHPA/PHPA and significantly lower VD and PI than PHPA (P < 0.05). HiFR CEUS showed perfusion appeared first in CHPA, then PHPA, and lastly ALPA.
SR and HiFR CEUS enable non-invasive, dynamic visualization and quantification of microvascular growth in distracted callus, revealing a "target ring sign", "bidirectional fusion" perfusion pattern, and "central-first, peripheral-second" perfusion sequence. ALPA was identified as a hypovascular zone potentially associated with delayed mineralization or cyst formation. This system provides a novel imaging framework for early assessment of callus viability, prediction of osteogenic risk, and guidance of individualized distraction strategies.

PMID:
42893706
Bibliographic data and abstract were imported from PubMed on 19 Oct 2026.

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